Tuesday,
September 18, 2007 - Suicide accounts for three-quarters of all violent deaths in Oregon, outnumbering homicides by more than 5-to-1, state health officials reported Monday.
What jumps out is not a trend -- slightly fewer suicides and other violent deaths in 2005 than the year before -- but the ongoing high numbers, said Dr. Mel Kohn, state epidemiologist.
"I guess we're trending in the right direction, but it's hard to get too excited about a number that is still very high," Kohn said. "We have a serious problem with suicide in Oregon."
Oregon is one of nine states where more people die by suicide than in vehicle crashes, said Lisa Millet, manager of the state's injury and violence prevention program and co-author of the new report. Suicides outnumber traffic fatalities 555 to 480.
In all, 748 Oregonians died violently in 2005, the state report found. Besides the suicides, 103 died by homicide. The rest died from police encounters, homicide-suicides, firearm accidents or cases where the exact cause could not be determined.
Aside from tallying violent deaths of all kinds in 2005, the report offers a statistical portrait of suicide in Oregon.
Suicide rates are higher among men and military veterans, and they rise steadily with age. Among Oregonians older than 65, the rate is 78 percent higher than the national average.
While women are more likely to attempt suicide, men are four times as likely to succeed. That's because men are more likely to use firearms, which tend to be lethal. Women are more likely to use poison or drug overdoses, which are fatal less often.
Oregon has the 10th-highest suicide rate in the nation, below eight other Western states and West Virginia, according to the federal Centers for Disease Control and Prevention. Rural isolation and high gun ownership are among the possible reasons.
Firearms account for nearly three-quarters of suicides and more than half of all violent deaths in Oregon.
"If someone who's at risk for depression has a gun available, that's not a good combination," Kohn said.
More than half of those who end their lives by suicide are seriously depressed. About 30 percent have a diagnosed mental illness, 17 percent have problems with alcohol, and 9 percent abuse drugs. Most suicides occur at home. One in five has made a suicide threat or a previous attempt.
Terminally ill people who end their lives by a doctor-prescribed drug overdose under Oregon's unique-in-the-nation Death With Dignity Act are not counted as suicides.
Curry and Klamath counties have suicide rates above the state average. Washington County is the only county with a rate significantly lower than the state average.
The report found that male military veterans are more than twice as likely to commit suicide as men of the same age who are not veterans. The exact reason is not clear. Researchers don't know how to weigh the relative importance of a veteran's personality and pre-military experience, the stress of being in combat, or familiarity with guns.
Every veteran returning to Oregon from Iraq undergoes a health screening designed to pick up signs of mental illness or vulnerability to post-traumatic stress disorder, said Ed Van Dyke, Portland manager for the Department of Veterans Affairs.
He estimates that 80 percent of veterans with severe PTSD "have a potential of being volatile and violent" to themselves or others.
"That's why it's so important to debrief these soldiers and screen them for possible mental health problems," he said.
The official recommendation to all health care providers in the state is to question patients about depression and other mental health problems. "But that's difficult when you have a patient who comes in with diabetes and arthritis for a 10-minute visit," said Millet, the state report's co-author.
Many people who die by suicide have known mental health problems but "either dropped out of care or weren't getting care in the first place," she said. "We need to do a better job of finding them."
But finding such people and matching them with effective care is not easy. Lack of insurance, overlapping financial and social problems and poor access to care are among the barriers.
And stigma. "People can't talk about their mental illness," Millet said, "the way they talk about their diabetes."
To see the full report:
http://www.oregon.gov/DHS/ph/ipe/nvdrs/index.shtml.
Don Colburn: 503-294-5124; doncolburn@news.oregonian.com
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